Acupuncture for functional dyspepsia: Bayesian meta-analysis

This Bayesian meta-analysis represents one of the most comprehensive studies performed to date on acupuncture for functional dyspepsia, analyzing 34 randomized clinical trials with 2,950 participants. Functional dyspepsia is a common gastrointestinal disorder characterized by chronic symptoms originating in the gastroduodenal region in the absence of systemic, organic, or metabolic disease, significantly affecting patients' quality of life.

The study used rigorous methodology, including systematic searches in eight electronic databases, risk-of-bias assessment using Cochrane tools, and Bayesian network meta-analysis to compare and rank the efficacy of different acupuncture therapies. The interventions analyzed included manual acupuncture, moxibustion, electroacupuncture, warm needling, cupping therapy, acupoint catgut embedding, transcutaneous electrical acupoint stimulation, and combinations of these techniques with conventional Western medicine.

The results demonstrated that acupuncture therapies, both independently and in combination with other modalities, emerged as safe and effective treatment options. For relief of early satiety, the combination of Western medicine with acupuncture proved most effective, followed by TEAS and manual acupuncture. For improvement of postprandial fullness, the Western medicine-acupuncture combination again led the ranking, demonstrating consistent superiority of integrated approaches.

For epigastric pain, the acupuncture-moxibustion combination proved to be the most effective treatment, while for burning sensation, moxibustion alone emerged as the optimal choice. For promoting motilin levels — an important gastrointestinal hormone — warm needling was identified as the preferred method, followed by electroacupuncture and combinations of warm needling with manual acupuncture.

The most frequently used acupuncture points included Weishu (BL-21), Pishu (BL-20), Zusanli (ST-36), Zhongwan (CV-12), Guanyuan (CV-4), and Tianshu (ST-25), all related to the digestive system in traditional Chinese medicine. Treatment duration ranged from 2 weeks to 3 months, with most studies showing significant benefits.

With respect to safety, only 10 studies reported adverse events, all of mild nature, including ecchymosis, localized swelling, discomfort, headache, and mild thirst resulting from acupuncture. A few isolated cases of diarrhea were attributed to conventional medications. No serious adverse events were recorded, reinforcing the favorable safety profile of acupuncture.

Limitations of the study include the exclusive inclusion of Chinese-language literature, significant variability in acupuncture techniques across practitioners, lack of standardization in treatment protocols, and heterogeneity in the types, dosages, and durations of Western medications used. In addition, most studies were of relatively short duration and lacked long-term follow-up.

This work provides robust evidence to guide clinical practice, suggesting that integrated approaches combining acupuncture with conventional medicine may offer benefits superior to isolated treatments. The results support the use of acupuncture as a valuable complementary therapy in the management of functional dyspepsia, with different techniques being more appropriate for specific symptoms.